MNHQ. any chance of you supporting the campaign for affordable insurance for Independent Midwives?

In 2010 the EU court of human rights stated that all women have the fundamental human right to choose how, where and with whom they want to give birth. The EU court held that governments cannot use force of the law to take away their options.

But sadly this is about to happen...This year, from October, a woman's ability to obtain the birth she wants will be restricted.

Independent midwives, who work outside the NHS and offer women a greater choice will become illegal. Their registration will depend upon obtaining personal indemnity insurance (PII). Currently independent midwives are exempt from obtaining PII as the annual cost of £80,000, is much greater than their annual salaries.

The NHS will become more of a monopoly restricting the choice many women have on how to give birth. Many NHS protocols mean that women are often advised or pushed into a more medicalised approach to their birth. Healthy breech or twin pregnancies are given no option other than caesareans. Many VBAC's (vaginal birth after caesareans) are also advised to have subsequent caesareans despite the risk of uterine rupture being only 0.5%.

Many women now have caesareans due to a failure to progress in labour or other labour difficulties. However, understanding the physiology of a labouring woman we can see that there are many environmental factors at work.

One of the fundamental necessities for a healthy labour is the correct functioning of the hormonal glands, the pituitary and hypothalamus. These glands are held in the primitive or "old" brain. Stimulation to the "new" brain or neocortex inhibits the correct secretion of these hormones needed for labour.

Factors which stimulate the new brain or neocortex and inhibit labouring hormones are:language, asking questionsbright lightsfeeling observed or a lack of privacy. All non-human mammals retreat to a dark environment alone from the group to labour.the production of adrenaline ( fear, pressure to perform, deadlines such as the need to dilate within a certain time frame)

If we consider a hospital labour ward environment with this in mind, the environment is not conducive to easily secreting the hormones of the primitive brain, vital for an easy labour.

By restricting options outside of the NHS means that labouring women have less choice, despite EU law, which may led to some women deciding they have no choice but to labour at home alone.

At beginning of the year, the Whittington hospital in London, closed down their specialist midwife led home birth team and replaced it with the community midwives. Community midwives have to juggle their normal duties with home births, affecting the time and care provided to birthing women.

On the other hand, if you have an Independent midwife, you would see the same 2 midwives throughout the pregnancy, who would get to know you as an individual. They can be called upon 24/7 with 28 days of post natal support provided for breastfeeding and other post natal advice and care. Independent midwives work with families who are planning a home birth or a hospital or birth centre birth.

Please sign the following government petition asking the government to provide an exemption or affordable PII to all independent midwives to allow mothers birthing choices to continue.http://epetitions.direct.gov.uk/petitions/44382

Please forward this to anyone else who would be interested in signing this, we only have until May to try and stop this from happening

However it does not provide information which answers the question I asked, which was a follow up to the assertion: "The cost of government underwriting PII setup for Independent Midwives would be cancelled out by women opting out of the NHS".

"A campaign called 'Choose Your Midwife, Choose Your Birth' has been mounted to protest this upcoming change and appeal to the government to find a workable solution that does not involve axing independent midwifery - a service David Cameron himself has referred to as the 'gold standard' of maternity care."

So, the campaign is wanting the government to find a workable solution to the changes they have recently ut in place, that will effectively make independent midwifery illegal, and could result in many women choosing to 'free birth', thus increasing risks for those women.

"The Royal College of Midwives (RCM) provided insurance cover to all its members until 1994. Following a case involving an independent midwife, the commercial insurers providing RCM cover became aware that they would need to pay out, since the midwife was self employed and therefore had no vicarious liability through an employer. As a result, the insurers immediately raised their premium to half a million pounds, which the RCM felt it could not afford. The College decided to exclude those members who practised independently from PII cover, in order to keep RCM premiums at an affordable level. "

"Some commercial cover was available until 2002 but the premiums kept escalating, despite an excellent claims history, until an annual premium was around £20,000 per midwife. As this was more than many independent midwives earned, most were forced to make the difficult decision to cease practising or practise uninsured."

Independent Midwives UK has been fighting this battle for many , many years, meditrina.

If you go to the link to the Independent Midwives UK website, and click on Professional Indemnity Insurance, the whole situation is explained very well. The page begins with this:

Currently there is no professional indemnity insurance available to Independent Midwives (IMs), which means we are personally liable for any negligence claim made against us. Midwives who are employed by the NHS are covered through their Trust which belongs to the Clinical Negligence Scheme for Trusts (CNST) run by the NHS Litigation Authority (NHSLA).

The Royal College of Midwives (RCM) provided insurance cover to all its members until 1994. Following a case involving an independent midwife, the commercial insurers providing RCM cover became aware that they would need to pay out, since the midwife was self employed and therefore had no vicarious liability through an employer. As a result, the insurers immediately raised their premium to half a million pounds, which the RCM felt it could not afford. The College decided to exclude those members who practised independently from PII cover, in order to keep RCM premiums at an affordable level.

It goes on to explain that independent midwives have been practicing without insurance since 2002, when the last insurer pulled out of providing cover due to no midwives being able to afford the high premiums.

Since, in the case of something going wrong during a 'medical' situation, the patient needs to prove in court that the practitioner was negligent, independent midwives have continued to practice without insurance, due to the fact that their practice is exemplary and they keep very careful records. They are careful also to monitor situations very carefully and take no risks with the health of either the mother or the baby.

There is no question of taxes being used to 'bail out' midwives. They are asking for this new law (that only insured midwives can practice) to be changed, or for insurance requirements to be changed, since midwives are currently insured in the same bracket as obstetrics, which an independent midwife's work would not stray into, since they would have advised the mother to go into hospital if there were such serious complications.

What is the definition of affordable? A lot of us in healthcare pay ludicrous amounts for professional indemnity insurance and I would object to one group of practitioners getting theirs subsidised or uinderwritten if other groups of us are battling on and paying ours unaided.

From what I can see, this is not a question of wanting Government to support them financially. The midwives are independent for a reason, and Govt financial backing would probably come at a price most would not want to pay (in terms of their policies and practices being heavily influenced by Govt, therefore stopping them from being independent).The rules being brought in by the Government are stating that midwives cannot practice without PII. PII will only be available to NHS midwives, effectively de-legalising independent midwifery, and removing choice from women.

If Parliament does nothing to help find a more amenable solution, an EU directive will come into effect on 25th October 2013 requiring all health care providers to have Professional Indemnity Insurance (PII) in order to register with the Care Quality Commission (CQC), a legal requirement to practise. This insurance is provided by the NHS for midwives working in its trusts, but cannot be obtained by those who work directly for the women they serve, independently. Without PII insurance, independent midwives may lose their registration and, in effect, become illegal. You can learn more about the directive on the Independent Midwives UK website. here

It could be that the insurers aren't aware of significant demand, in which case publicising that demand would help, or are unaware of registration requirements which presumably ensure a midwife is qualified? In either case dialogue by people who know all the details is needed.

Is it thought the insurance companies should subsidise the insurance? (Unlikely, as shareholder-owned)

Is it thought the government should subsidise the insurance / provide cover for independent midwives? I would object to taxes being used to fund insurance for independent midwives when taxes already pay for the NHS.

I can see that people feel they would like an alternative, but am very uncomfortable that that should be paid for out of taxes. The alternative I suppose is to allow midwives to practise without insurance. I wouldn't be comfortable using one without insurance myself, but that is maybe the only option if someone decides to opt out of the state-provided NHS option.